Heel Spurs

Heel spurs are pointed, bony outgrowths of the heel that cause soft-tissue inflammation.

• A heel spur is a pointed bony outgrowth of the heel bone (the calcaneus bone).
• The build-up of calcium deposits under the heel bone causes heel spurs.
• Heel spurs under the sole of the foot (plantar area) are associated with plantar fasciitis (inflammation of the plantar fascia ligament at the bottom of the foot).
• Heel pain is a common symptom of heel spurs.
• Heel spurs and plantar fasciitis can occur alone or be related to underlying diseases.
• Heel spurs are treated by anti-inflammatory medications, orthotics, and other measures that decrease the associated inflammation and avoid reinjury.

A heel spur is a pointed bony outgrowth of the bone of the heel (the calcaneus bone). Chronic local inflammation at the insertion of soft-tissue tendons or plantar fascia is a common cause of bone spurs (osteophytes). Heel spurs can be located at the back of the heel or under the heel, beneath the arch of the foot. Heel spurs at the back of the heel are frequently associated with inflammation of the Achilles tendon (tendinitis) and cause tenderness and heel pain made worse while pushing off the ball of the foot.

Heel spurs under the sole of the foot (plantar area) are associated with inflammation of the plantar fascia (plantar fasciitis), the "bowstring-like" ligament stretching underneath the sole that attaches at the heel. Plantar heel spurs cause localized tenderness and heel pain made worse when stepping down on the heel.

Heel spurs and plantar fasciitis can occur alone or be related to underlying diseases that cause arthritis (inflammation of the joints), such as reactive arthritis (formerly called Reiter's disease), ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis (DISH). It is important to note that heel spurs may cause no symptoms at all and may be incidentally discovered during X-ray exams taken for other purposes.

Heel spurs are diagnosed based on the history of heel pain and tenderness localized to the area of bony involvement. They are specifically identified when there is point tenderness at the bottom of the heel, which makes it difficult to walk barefoot on hard surfaces, like tile or wood floors. X-ray examination of the foot is used to identify the bony prominence (spur) of the heel bone (calcaneus).

Heel spurs are treated by measures that decrease the associated inflammation and avoid reinjury. Local ice applications both reduce pain and inflammation. Anti-inflammatory medications, such as naproxen (Aleve) and ibuprofen (Advil), or injections of cortisone, are often helpful.

Orthotic devices or shoe inserts are used to take pressure off plantar spurs (donut-shaped insert), and heel lifts can reduce stress on the Achilles tendon to relieve painful bone spurs at the back of the heel. Similarly, sports running shoes with soft, cushioned soles can be helpful in reducing irritation of inflamed tissues from heel spurs. Infrequently, surgery is performed on chronically inflamed spurs.

The long-term outlook is generally good. The inflammation usually responds to conservative, nonsurgical treatments, like anti-inflammatory drugs and orthotics. Infrequently, surgical intervention is necessary.

Treating any underlying associated inflammatory disease can prevent heel spurs.